Extreme weather events and maternal health in low-income and middle-income countries: a scoping review.

BACKGROUND: Despite global efforts to improve maternal health and healthcare, women throughout the world endure poor health during pregnancy. Extreme weather events (EWE) disrupt infrastructure and access to medical services, however little is known about their impact on the health of women during pregnancy in resource-poor settings. OBJECTIVES: This review aims to examine the current literature on the impact of EWE on maternal health to identify the pathways between EWE and maternal health in low-income and middle-income countries to identify gaps. ELIGIBILITY CRITERIA: Studies were eligible for inclusion if they were published before 15 December 2022 and the population of the studies included pregnant and postpartum women (defined at up to 6 weeks postpartum) who were living in low-income and middle-income countries. The exposure of the included study must be related to EWE and the result to maternal health outcomes. SOURCES OF EVIDENCE: We searched the literature using five databases, Medline, Global Health, Embase, Web of Science and CINAHL in December 2022. We assessed the results using predetermined criteria that defined the scope of the population, exposures and outcomes. In total, 15 studies were included. CHARTING METHODS: We identified studies that fit the criteria and extracted key themes. We extracted population demographics and sampling methodologies, assessed the quality of the studies and conducted a narrative synthesis to summarise the key findings. RESULTS: Fifteen studies met the inclusion criteria. The quantitative studies (n=4) and qualitative (n=11) demonstrated an association between EWE and malnutrition, mental health, mortality and access to maternal health services. CONCLUSION: EWE negatively impact maternal health through various mechanisms including access to services, stress and mortality. The results have demonstrated concerning effects, but there is also limited evidence surrounding these broad topics in low-resource settings. Research is necessary to determine the mechanisms by which EWE affect maternal health. PROSPERO REGISTRATION NUMBER: CRD42022352915.

Identification of maladaptive behavioural patterns in response to extreme weather events.

Human behaviour has gained recognition as a critical factor in addressing climate change and its impacts. With extreme weather events posing risks to vulnerable communities, understanding cognitive processes driving behaviours becomes essential for effective risk communication. This study focuses on the 2018 "Vaia" storm, which brought unprecedented precipitation and wind velocity to the mountainous regions of North-eastern Italy. Drawing upon the Protection Motivation Theory (PMT) framework, we employ probabilistic models to identify distinct groups with similar behavioural profiles. By administering a web-based survey to 1500 residents affected by the event, we find that threat appraisal is more influential in shaping protective behaviours than coping appraisal. Our findings indicate that by enhancing coping appraisals and discouraging non-protective measures, we can actively mitigate maladaptive responses and promote the adoption of effective adaptation strategies.

The effect of different extreme weather events on attitudes toward climate change.

Can exposure to extreme weather change political opinion and preferences about climate change? There is a growing literature on both the effects of extreme weather events and the factors explaining attitudes toward global warming, though there remains no clear consensus about whether being exposed to extreme weather influences public opinion about climate change. We contribute to this literature by studying the impact of a variety of extreme weather events associated with climate variability, including severe storms, floods, fires, and hurricanes, on attitudes toward climate change. Specifically, we use a three-wave panel survey and a dynamic difference-in-differences design to analyze public opinion data at the individual level in the US. We find that exposure to only one extreme weather type-fires-has a small but significant effect on acknowledging the existence of climate change and supporting the need for action. However, that impact quickly vanishes, and other types of extreme weather do not appear to have any effect on opinion.

Compound mortality impacts from extreme temperatures and the COVID-19 pandemic.

Extreme weather and coronavirus-type pandemics are both leading global health concerns. Until now, no study has quantified the compound health consequences of the co-occurrence of them. We estimate the mortality attributable to extreme heat and cold events, which dominate the UK health burden from weather hazards, in England and Wales in the period 2020-2022, during which the COVID-19 pandemic peaked in terms of mortality. We show that temperature-related mortality exceeded COVID-19 mortality by 8% in South West England. Combined, extreme temperatures and COVID-19 led to 19 (95% confidence interval: 16-22 in North West England) to 24 (95% confidence interval: 20-29 in Wales) excess deaths per 100,000 population during heatwaves, and 80 (95% confidence interval: 75-86 in Yorkshire and the Humber) to 127 (95% confidence interval: 123-132 in East of England) excess deaths per 100,000 population during cold snaps. These numbers are at least ~2 times higher than the previous decade. Society must increase preparedness for compound health crises such as extreme weather coinciding with pandemics.

Bivariate extreme value analysis of extreme temperature and mortality in Canada, 2000-2020.

Climate change increases the risk of illness through rising temperature, severe precipitation and worst air pollution. This paper investigates how monthly excess mortality rate is associated with the increasing frequency and severity of extreme temperature in Canada during 2000-2020. The extreme associations were compared among four age groups across five sub-blocks of Canada based on the datasets of monthly T90 and T10, the two most representative indices of severe weather monitoring measures developed by the actuarial associations in Canada and US. We utilize a combined seasonal Auto-regressive Integrated Moving Average (ARIMA) and bivariate Peaks-Over-Threshold (POT) method to investigate the extreme association via the extreme tail index χ and Pickands dependence function plots. It turns out that it is likely (more than 10%) to occur with excess mortality if there are unusual low temperature with extreme intensity (all χ > 0.1 except Northeast Atlantic (NEA), Northern Plains (NPL) and Northwest Pacific (NWP) for age group 0-44), while extreme frequent high temperature seems not to affect health significantly (all χ ≤ 0.001 except NWP). Particular attention should be paid to NWP and Central Arctic (CAR) since population health therein is highly associated with both extreme frequent high and low temperatures (both χ = 0.3182 for all age groups). The revealed extreme dependence is expected to help stakeholders avoid significant ramifications with targeted health protection strategies from unexpected consequences of extreme weather events. The novel extremal dependence methodology is promisingly applied in further studies of the interplay between extreme meteorological exposures, social-economic factors and health outcomes.

Effects of extreme meteorological factors and high air pollutant concentrations on the incidence of hand, foot and mouth disease in Jining, China.

Background: The evidence on the effects of extreme meteorological conditions and high air pollution levels on incidence of hand, foot and mouth disease (HFMD) is limited. Moreover, results of the available studies are inconsistent. Further investigations are imperative to elucidate the specific issue. Methods: Data on the daily cases of HFMD, meteorological factors and air pollution were obtained from 2017 to 2022 in Jining City. We employed distributed lag nonlinear model (DLNM) incorporated with Poisson regression to explore the impacts of extreme meteorological conditions and air pollution on HFMD incidence. Results: We found that there were nonlinear relationships between temperature, wind speed, PM2.5, SO2, O3 and HFMD. The cumulative risk of extreme high temperature was higher at the 95th percentile (P95th) than at the 90th percentile(P90th), and the RR values for both reached their maximum at 10-day lag (P95th RR = 1.880 (1.261-2.804), P90th RR = 1.787 (1.244-2.569)), the hazardous effect of extreme low temperatures on HFMD is faster than that of extreme high temperatures. The cumulative effect of extreme low wind speeds reached its maximum at 14-day lag (P95th RR = 1.702 (1.389-2.085), P90th RR = 1.498(1.283-1.750)). The cumulative effect of PM2.5 concentration at the P90th was largest at 14-day lag (RR = 1.637 (1.069-2.506)), and the cumulative effect at the P95th was largest at 10-day lag (RR = 1.569 (1.021-2.411)). High SO2 concentration at the P95th at 14-day lag was associated with higher risk for HFMD (RR: 1.425 (1.001-2.030)). Conclusion: Our findings suggest that high temperature, low wind speed, and high concentrations of PM2.5 and SO2 are associated with an increased risk of HFMD. This study not only adds insights to the understanding of the impact of extreme meteorological conditions and high levels of air pollutants on HFMD incidence but also holds practical significance for the development and enhancement of an early warning system for HFMD.

Infectious Diseases in a Changing Climate.

This JAMA Insights in the Climate Change and Health series discusses the importance of clinicians having awareness of changes in the geographic range, seasonality, and intensity of transmission of infectious diseases to help them diagnose, treat, and prevent these diseases.

Inequities in the Impacts of Hurricanes and Other Extreme Weather Events for Cancer Survivors.

In this minireview, we examine the impacts of hurricanes and other extreme weather events on cancer survivors, focusing on structural and social determinants of health. We briefly explore influences on biological, psychosocial, and behavioral outcomes and discuss risk and resilience factors in cancer survivorship during and after hurricanes. Our goal is to inform future directions for research that can identify areas in which we can most efficiently improve cancer outcomes and inform changes in health systems, clinical practice, and public health policies. This timely minireview provides researchers and clinicians with an overview of challenges and opportunities for improving disaster preparedness and response for cancer survivors.

Impact of extreme weather events on mental health in South and Southeast Asia: A two decades of systematic review of observational studies.

Extreme weather events in South and Southeast Asia exert profound psychosocial impacts, amplifying the prevalence of mental illness. Despite their substantial consequences, there is a dearth of research and representation in the current literature. We conducted a systematic review of observational studies published between January 1, 2000, and January 20, 2024, to examine the impact of extreme weather events on the mental health of the South and Southeast Asian population. Quality assessment of the included studies was conducted using the Newcastle-Ottawa Scale (NOS) quality appraisal checklist. The search retrieved 70 studies that met the inclusion criteria and were included in our review. Most were from India (n = 22), and most used a cross-sectional study design (n = 55). Poor mental health outcomes were associated with six types of extreme weather events: floods, storm surges, typhoons, cyclones, extreme heat, and riverbank erosion. Most studies (n = 41) reported short-term outcome measurements. Findings included outcomes with predictable symptomatology, including post-traumatic stress disorder, depression, anxiety, general psychological distress, emotional distress and suicide. Limited studies on long-term effects showed higher mental disorders after floods and typhoons, while cyclone-exposed individuals had more short-term distress. Notably, the review identified over 50 risk factors influencing mental health outcomes, categorized into six classes: demographic, economic, health, disaster exposure, psychological, and community factors. However, the quantitative evidence linking extreme weather events to mental health was limited due to a lack of longitudinal data, lack of control groups, and the absence of objective exposure measurements. The review found some compelling evidence linking extreme weather events to adverse mental health in the South and Southeast Asia region. Future research should focus on longitudinal study design to identify the specific stressors and climatic factors influencing the relationship between climate extremes and mental health in this region.

Impact of extreme weather events on healthcare utilization and mortality in the United States.

Climate change is intensifying extreme weather events. Yet a systematic analysis of post-disaster healthcare utilization and outcomes for severe weather and climate disasters, as tracked by the US government, is lacking. Following exposure to 42 US billion-dollar weather disasters (severe storm, flood, flood/severe storm, tropical cyclone and winter storm) between 2011 and 2016, we used a difference-in-differences (DID) approach to quantify changes in the rates of emergency department (ED) visits, nonelective hospitalizations and mortality between fee-for-service Medicare beneficiaries in affected compared to matched control counties in post-disaster weeks 1, 1-2 and 3-6. Overall, disasters were associated with higher rates of ED utilization in affected counties in post-disaster week 1 (DID of 1.22% (95% CI, 0.20% to 2.25%; P < 0.020)) through week 2. Nonelective hospitalizations were unchanged. Mortality was higher in affected counties in week 1 (DID of 1.40% (95% CI, 0.08% to 2.74%; P = 0.037)) and persisted for 6 weeks. Counties with the greatest loss and damage experienced greater increases in ED and mortality rates compared to all affected counties. Thus, billion-dollar weather disasters are associated with excess ED visits and mortality in Medicare beneficiaries. Tracking these outcomes is important for adaptation that protects patients and communities, health system resilience and policy.

The impact of extreme weather events exceeds those due to global-change drivers on coastal phytoplankton assemblages.

Extreme wind and rainfall events have become more frequent phenomena, impacting coastal ecosystems by inducing increased mixing regimes in the upper mixed layers (UML) and reduced transparency (i.e. browning), hence affecting phytoplankton photosynthesis. In this study, five plankton assemblages from the South Atlantic Ocean, from a gradient of environmental variability and anthropogenic exposure, were subjected to simulated extreme weather events under a global change scenario (GCS) of increased temperature and nutrients and decreased pH, and compared to ambient conditions (Control). Using multiple linear regression (MLR) analysis we determined that evenness and the ratio of diatoms/ (flagellates + dinoflagellates) significantly explained the variations (81-91 %) of the photosynthesis efficiency (i.e. Pchla/ETRchla ratio) for each site under static conditions. Mixing speed and the optical depth (i.e. attenuation coefficient * depth, kdz), as single drivers, explained 40-76 % of the variability in the Pchla/ETRchla ratio, while GCS drivers <9 %. Overall, assemblages with high diversity and evenness were less vulnerable to extreme weather events under a GCS. Extreme weather events should be considered in global change studies and conservation/management plans as even at local/regional scales, they can exceed the predicted impacts of mean global climate change on coastal primary productivity.

Behavioral responses of intertidal clams to compound extreme weather and climate events.

Rapidly increasing concentration of carbon dioxide (CO2) in the atmosphere not only results in global warming, but also drives increasing seawater acidification. Infaunal bivalves play critical roles in benthic-pelagic coupling, but little is known about their behavioral responses to compound climate events. Here, we tested how heatwaves and acidification affected the behavior of Manila clams (Ruditapes philippinarum). Under acidified conditions, the clams remained capable of burrowing into sediments. Yet, when heatwaves attacked, significant decreases in burrowing ability occurred. Following two consecutive events of heatwaves, the clams exhibited rapid behavioral acclimation. The present study showed that the behavior of R. philippinarum is more sensitive to heatwaves than acidification. Given that the behavior can act as an early and sensitive indicator of the fitness of intertidal bivalves, whether, and to what extent, behavioral acclimation can persist under scenarios of intensifying heatwaves in the context of ocean acidification deserve further investigations.

Unusual outbreaks of curly top disease in processing tomato fields in northern California in 2021 and 2022 were caused by a rare strain of beet curly top virus and facilitated by extreme weather events.

In the western United States, curly top disease (CTD) is caused by beet curly top virus (BCTV). In California, CTD causes economic loss to processing tomato production in central and southern areas but, historically, not in the north. Here, we document unusual CTD outbreaks in processing tomato fields in the northern production area in 2021 and 2022, and show that these were caused by the rare spinach curly top strain (BCTV-SpCT). These outbreaks were associated with proximity of fields to foothills and unusually hot, dry, and windy spring weather conditions, possibly by altering migrations of the beet leafhopper (BLH) vector from locations with BCTV-SpCT reservoirs. Support for this hypothesis came from the failure to observe CTD outbreaks and BLH migrations in 2023, when spring weather conditions were cool and wet. Our results show the climate-induced emergence of a rare plant virus strain to cause an economically important disease in a new crop and location.

An early warning approach for the rapid identification of extreme weather disasters based on phased array dual polarization radar cooperative network data.

In recent years, X-band phase array dual polarization weather radar technology has matured. The cooperative networking data from X-band phase array dual polarization weather radar have many advantages compared with traditional methods, namely, high spatial and temporal resolution (approximately 70 seconds in one scan, 30 m in radial distance resolution), wide coverages that can compensate for the observation blind spots, and data fusion technology that is used in the observation overlap area to ensure that the observed precipitation data have spatial continuity. Based on the above radar systems, this study proposes an improved hail and lightning weather disaster rapid identification and early warning algorithm. The improved thunderstorm identification, tracking, analysis, and nowcasting (TITAN) algorithm is used to quickly identify three-dimensional strong convective storm cells. Large sample observation experiment data are used to invert the localized hail index (HDR) to identify the hail position. The fuzzy logic method is used to comprehensively determine the probability of lightning occurrence. The comparative analysis experiment shows that, compared with the live observation data from the ground-based automatic station, the hail and lightning disaster weather warning algorithm developed by this study can increase warning times by approximately 7 minutes over the traditional algorithm, and its critical success index (CSI), false alarm ratio (FAR) and omission alarm ratio (OAR) scores are better than those of the traditional method. The average root mean square error (ARMSE) for identifying hail and lightning locations by this improved method is also significantly better than that of traditional methods. We show that our method can provide probabilistic predictions that improve hail and lightning identification, improve the precision of early warning and support operational utility at higher resolutions and with greater lead times that traditional methods struggle to achieve.

A Germany-wide survey of caregiving professionals on climate change and mental health of children and adolescents - factors influencing their relevance rating of extreme weather event associated mental health impairments.

INTRODUCTION: Climate change presents a significant risk for the mental and physical health of young people. In order to identify and properly care for potential mental health impairments from extreme weather events, the relevance of these impairments must be assessed as high by the professional groups providing care for children and adolescents. This raises the question of which factors influence the individual relevance assessment of caretaking professionals? METHODS: Data was collected creating and conducting a Germany-wide online questionnaire via LimeSurvey. The questionnaire was addressed to professionals providing care for children and adolescents, in this case medical and therapeutic personnel as well as school and pedagogical personnel. Professional associations, chief physicians and school principals were contacted as multipliers and asked to forward the questionnaire to their members and staff. The data was analyzed using the R statistical software, and multiple linear regressions were performed to test the hypotheses. RESULTS: Overall, 648 questionnaires were taken into analysis. Approximately 70% of the participants considered climate change-induced impacts on the mental health of children and adolescents due to extreme weather events as relevant. Experiencing heat, storm, heavy precipitation, flood/flooding, and/or avalanches/mudflows made a modest yet significant contribution to explaining higher relevance assessments. In contrast, there was no evidence to suggest that an urban working environment increases the relevance assessment. CONCLUSION: The described influence of experiencing extreme weather events should not be regarded as the sole factor leading to higher relevance ratings. A more comprehensive understanding of the factors influencing relevance assessments is necessary to address key aspects of risk communication and increase risk awareness.